Victoria Pueyo

Reproducibility of Optical Coherence Tomography Measurements in Children

PURPOSE To determine the interobserver and intraobserver reproducibility of a Fourier-domain optical coherence tomography device (Cirrus HD OCT; Carl Zeiss Meditec, Dublin, California, USA) in normal pediatric eyes. DESIGN Prospective cross-sectional study. METHODS One hundred healthy children were recruited prospectively and consecutively. Only 1 randomly chosen eye per subject was included in the study. The eye underwent 3 scans centered on the optic disc and another 3 scans centered on the macula that were acquired by a single operator. A fourth examination was performed by a second operator. Interobserver and intraobserver reproducibility were described by intraclass correlation coefficients (ICCs) and coefficients of variation (COVs). RESULTS The mean age was 9.15 years (range, 6.22 to 11.31 years; standard deviation, 1.05 years). Mean retinal nerve fiber layer thickness was 99.53 μm (standard deviation, 10.10 μm), and mean macular thickness was 282.91 μm (standard deviation, 11.83 μm). All the parameters evaluated were highly reproducible. Intraobserver COVs of the retinal nerve fiber layer measurements ranged from 2.24% to 5.52%, and the COV of macular thickness was 0.97%. The intraclass correlation coefficient was greater than 0.8 for all the parameters. The interobserver COV ranged from 2.23% to 5.18%, and the COV of macular thickness was 0.82%. In all the evaluated parameters, the intraclass correlation coefficient was more than 0.75. Repeatability was slightly better in children older than 10 years than in children younger than 9 years. CONCLUSIONS Retinal nerve fiber layer and macular measurements obtained by Fourier-domain optical coherence tomography showed good repeatability for healthy eyes in the pediatric population. Cirrus HD OCT examinations of the retina are reliable in children.

Sub‐clinical atrophy of the retinal nerve fibre layer in multiple sclerosis

Acta Ophthalmol. 2010: 88: 748–752

Validity of the American College of Rheumatology Criteria for the Diagnosis of Giant Cell Arteritis

PURPOSE To assess the clinical utility of the American College of Rheumatology criteria for the diagnosis of giant cell arteritis (GCA) in patients with positive and negative temporal artery biopsies. DESIGN Retrospective case series of all patients undergoing temporal artery biopsy. METHODS Retrospective chart review of all patients seen in the Neuro-ophthalmology Service of the Wills Eye Institute undergoing biopsy. One hundred twelve patients were identified between October 2001 and May 2006. Charts were reviewed for American College of Rheumatology criteria, biopsy results, and progression of visual loss after diagnosis. RESULTS Nine of 35 patients (25.7%) with positive biopsies would not have been diagnosed with GCA using American College of Rheumatology criteria alone. An additional 16 patients (45.7%) met only 2 criteria and required the positive biopsy to establish the American College of Rheumatology diagnosis of GCA. Eleven of 39 patients (28.2%) with negative biopsies met the criteria and would have been diagnosed with GCA. Diagnostic agreement between the American College of Rheumatology criteria without biopsy results and biopsy results alone was 51.4%; with the addition of biopsy results to the criteria, this increased to 73.0%. CONCLUSIONS The current American College of Rheumatology criteria should not be used to diagnose GCA and all patients suspected of having GCA should undergo a temporal artery biopsy.

Normal reference ranges of optical coherence tomography parameters in childhood

Objective To report normal reference values for peripapillary retinal nerve fibre layer (RNFL) thickness and optic disc parameters in children from a community population. Methods The authors performed a cross-sectional study examining RNFL and optic nerve head (ONH) properties in 358 children aged between 6 and 13 years with no ocular disease. All children underwent an ophthalmic examination that included visual acuity (logMAR), stereopsis assessment (TNO) and optical coherence tomography (Cirrus OCT Zeiss, ‘Optic Disc Cube 200×200’ protocol). One eye from each subject selected at random was finally analysed. The authors evaluated the influence of height, gender and age on measurements. Results High-quality scan data were obtained from 357 children and 344 were finally included. The mean age (SD) was 9.16 (1.7) years and the mean (SD) RNFL average thickness was 98.46 (10.79) μm. The temporal quadrant showed the thinnest RNFL (69.35±11.28 μm), followed by the nasal (71.30±13.45 μm), superior (123.65±19.49 μm) and inferior (130.18±18.13 μm) quadrants. The mean rim area (SD) and disc area (SD) were 1.59 (0.33) and 2.05 (0.39) mm2, respectively. The average cup to disc (C:D) ratio (SD) was 0.43 (0.19). The authors found no differences in any of the parameters with regard to weight, height and gender. Conclusions This study demonstrates normative values of RNFL thickness and ONH parameters in a sample of Caucasian children from the general population.

Retinal Nerve Fiber Layer Evaluation in Open-Angle Glaucoma

Purpose: To determine the optimum criteria for optical coherence tomography (OCT) to discriminate best between healthy and glaucomatous eyes. Design: A prospective cross-sectional study. Methods: In total, 164 eyes selected from clinical practice were included in this study. These were classified into 98 healthy and 66 glaucomatous eyes, depending on the intraocular pressure, appearance of the optic disc and standard automated perimetry results. Only 1 eye per subject was randomly included. The retinal nerve fiber layer (RNFL) was evaluated by means of OCT (Stratus OCT 3000). The sensitivity and specificity values of different diagnostic criteria (4 abnormal quadrants and 1–5 abnormal clock-hours) were calculated with different probability levels (p < 0.05 and p < 0.01). Results: The criterion with the best sensitivity-specificity balance was the presence of ≥2 hour positions with an RNFL thickness outside of the 95% confidence interval (CI; sensitivity = 77.2%, specificity = 91.9%). For the 99% CI, the best criterion was the presence of at least 1 abnormal hour position (sensitivity = 71.2%, specificity = 91%). Regarding retinal quadrants, the presence of at least 1 quadrant with RNFL thickness outside of the CI was the criterion that best discriminated the existence of glaucomatous damage. Conclusions: The definition of diagnostic criteria based on OCT structural parameters may improve its diagnostic ability. The highest diagnostic ability was provided by the presence of at least 2 hour positions or RNFL average thickness outside the 95% CI.

Retinal structure assessed by OCT as a biomarker of brain development in children born small for gestational age

Purpose To identify differences in neuronal tissue from retinal and brain structures in children born small for gestational age (SGA) with no abnormality in neonatal brain ultrasonography and no previous neurological impairment, and to evaluate the relationship between retinal structure and brain changes in school-age children born SGA. Methods Two cohorts of children were recruited: 25 children born SGA and 25 children born with an appropriate birth weight according to gestational age. All the children underwent an ophthalmic examination, which included retinal imaging using spectral-domain optical coherence tomography, and a brain MRI. MRI images were automatically segmented and global and regional brain volumes were obtained. Results Although visual function did not differ between both groups, the complex ganglion cell and inner plexiform layers (GCL-IPL) was thinner in SGA children. Total intracranial volume, and global grey and white matter volumes in brain and cerebellum were correlated with birthweight centile, as were certain regional volumes (temporal and parietal lobes, hippocampus and putamen). Abnormal GCL-IPL measurements accurately identified SGA children with the most severe grey and white matter changes in the brain. Conclusions SGA children, both preterm and term born, showed evidence of structural abnormalities in the retina, which may be an accurate and non-invasive biomarker of neuronal damage in brain tissue.